Best Advice: Give It a Shot

One of the best pieces of advice I’ve ever received sounds pretty simple: Give it a shot.

Dr. Ted Alyea, a senior resident at the Brigham and Women’s Hospital in Boston, gave me this advice in 1991 when I was the most junior of physicians, an intern.

We were standing outside a patient’s room in the Intensive Care Unit. Our team was discussing the plan for treating a very sick patient when Ted said to me, “Tell us what you think we should do next. Give it a shot.”

During patient rounds, interns take turns outside a hospital room presenting the patient’s background; reciting what is known about the patient and the disease or condition including careful recounting of symptoms, laboratory data, diagnostic studies and current treatment. Then the intern and senior resident go into the room to examine the patient and afterward the team decides on a plan for treatment.

But taking Ted’s advice wasn’t so simple. Brigham & Women’s is essentially a referral hospital for the world. Extremely complicated cases come through the door each day, and some of the most brilliant, accomplished physicians on the planet treat these patients. For a lowly intern in this setting, just giving it a shot seemed risky. What if I was completely wrong and I recommended something that might hurt the patient in a potentially life or death situation? Would anyone trust me again?

Still, the task for me was clear. I had to collect all the data, think carefully, and be prepared to defend my recommendations.

And there was even more to his advice.

Ted put it this way: “Give it a shot and if someone else has a better idea, just say, ‘Thank you, that’s a better idea.’” In other words, you had to have the courage to offer an opinion but you also must have the humility to be thankful to those who contradicted you, even if it was a fellow intern, because the most important goal is to do the best for the patient.

I now run an organization of more than 15,000 staff. At the World Bank Group, a 70-year-old multilateral institution, hierarchies are well established and sometimes more junior people don’t have the opportunity to express their opinions. We are committed to doing whatever we can to change the culture, so that people at all levels of the organization will listen to each other. But it’s not easy and large bureaucracies are resistant to change.

Malcolm Gladwell wrote in his book, Outliers, about the danger of cultures that don’t encourage open debate across levels of an organization. He described a series of crashes of aircraft owned by an Asian company that was attributed, in part, to a culture of deference that meant junior pilots rarely, if ever, challenged their senior counterparts.

Once this was recognized, new approaches to training produced some of the safest airlines in the world. His point is inescapable: rigid hierarchies can be stultifying and more importantly, they can be deadly. Rigid hierarchies work against the introduction and spread of good or new ideas. Employees can become alienated, turning them into passive listeners who watch a plane crash or a patient die.

Since those days as an intern in Boston, Ted’s advice continues to inspire me. But I’ve become all too aware of just how difficult it is to create new cultures of openness and respect in hierarchical organizations. We’re making progress at the World Bank Group but we have a lot more work to do.

Courage and humility — just give it a shot and if someone has a better idea, say, thank you, that’s a better idea. For CEOs, that’s the kind of culture you need to create in your organization. For junior staff, you must insist on speaking up when you have a thoughtful idea. You never know — lives may depend on it.